As part of the treatment for trauma and many types of disease processes it is often necessary to join blood vessels to re-establish blood flow to some portion of the body or to an organ. Such joinder of blood vessels is referred to as vascular anastomosis. In the past, the primary method of closing vascular anastomosis sites has been manual suturing; this continues to be the method of choice for vascular anastomosis in most surgical subspecialties and procedures. In the majority of surgical procedures there is adequate time and the surgical site is suitable for manual suturing to be used for vascular anastomosis. For example, in most cardiac bypass surgeries, the surgical approach and anesthetic regimen traditionally employed have allowed the access and site stability necessary for manual suturing of any required vascular anastomosis.
Traditional coronary bypass surgery involves splitting and retracting the patient's sternum and opening the thoracic cavity. The invasive nature of the standard cardiac bypass surgical approach carries with it a significant cost in morbidity and mortality. Less invasive surgical methods would offer faster healing times with potentially less pain and fewer post-surgical complications.
Recently, cardiac bypass surgery has been moving toward less invasive surgical approaches. Although some endoscopic cardiac surgeries have been described, endoscopic cardiac bypass surgery has not been possible. Endoscopic cardiac bypass surgery raises at least two major technical problems related to vascular anastomosis: 1) the surgical exposure and surgical manipulation do not allow for manual suturing; and 2) anastomosis of the vessels adjacent to the beating heart must occur while the vessels are moving. Thus, the ability to anastomose vessels during endoscopic cardiac bypass surgery would provide a method of joining the vessels without the use of manual sutures while at least one of the vessels is in motion. No vascular anastomosis techniques currently in practice are suitable for performing vascular anastomosis through a small surgical window, such as those created for a laparoscope, or via endoscopy and under circumstances wherein at least one of the vessels is in motion or an organ in the surgical field is in motion.
Even without the restrictions imposed by a limited surgical exposure and a moving blood vessel, manual suturing has another problematic characteristic: it is time consuming. There has, therefore, always been incentive to find a method of vascular anastomosis that provides the strength and reliability of manual suturing but which can be performed more rapidly. Faster anastomotic techniques would lead to shorter surgical times, thereby decreasing patient morbidity and mortality stemming from surgical procedures, especially extended procedures. The present invention also addresses this problem by providing a rapid method of performing vascular anastomosis.